Showing papers in "Medicine Science and The Law in 1985"
TL;DR: A two-year retrospective study of patient assaults on staff in a large British psychiatric hospital was conducted, and an upward trend in assaults was noted.
Abstract: A two-year retrospective study of patient assaults on staff in a large British psychiatric hospital was conducted. An upward trend in assaults was noted. Information on high risk locations, and hig...
113 citations
TL;DR: Using a sample of imprisoned arsonists, an attempt is made to present a more refined classification of motivation than has been offered in the past.
Abstract: Using a sample of imprisoned arsonists, an attempt is made to present a more refined classification of motivation than has been offered in the past. The need for psychiatric opinion on all arsonists is stressed.
60 citations
TL;DR: Nine cases where the diagnosis could only be made on the basis of histological studies of diffuse axonal injury are described.
Abstract: Diffuse axonal injury is one of the most important types of brain damage that can occur in the course of a head injury. Its presence can usually be predicted post-mortem because of the presence of focal macroscopic abnormalities in the corpus callosum and in the brain stem. This report describes nine cases where the diagnosis could only be made on the basis of histological studies.
49 citations
TL;DR: The literature on patterns of seclusion is reviewed, as are studies of patients' attitudes towards it, which appear largely negative, and the implications of these findings for current practice are considered.
Abstract: Seclusion remains a widely used technique of emergency management in psychiatric institutions. Theoretical justification for its employment includes the need for safety and containment and decrease...
46 citations
25 citations
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TL;DR: A retrospective survey of fatalities in the bath during the period 1934–83 is presented, finding two cases of homicide; one being the murder of a child, the other a case of manual strangulation, the body having subsequently been placed in thebath.
Abstract: A retrospective survey of fatalities in the bath during the period 1934–83 is presented. The deaths were investigated in the Department of Legal Medicine at the University of Ghent. More than half of the deaths were caused by carbon monoxide intoxication (52 per cent). The remaining deaths were due to suicide (20 per cent), natural causes, e.g. epilepsy or cardiac arrest (8.5 per cent) or to accidental drowning, e.g. unattended infants (8.5 per cent). We found two cases of homicide; one being the murder of a child, the other a case of manual strangulation, the body having subsequently been placed in the bath.In one unusual case the autopsy was not performed until after the body had been buried for eight months. Although murder was suspected, neither the autopsy nor toxicological findings revealed the exact cause of death.
25 citations
TL;DR: This paper presents the results of an entomological investigation of a case of murder committed in South Yorkshire during 1980 where the victim was a 70-year-old woman who lived alone in a terraced house.
Abstract: This paper presents the results of an entomological investigation of a case of murder committed in South Yorkshire during 1980. The victim was a 70-year-old woman who lived alone in a terraced house.
23 citations
TL;DR: An examination of the gastric contents is an essential element of a forensic autopsy and the revelation of pathology or ingested drugs and poisons may be of obvious significance.
Abstract: INTRODUCTION An examination of the gastric contents is an essential element of a forensic autopsy and the revelation of pathology or ingested drugs and poisons may be of obvious significance. Also of recognized value is the matching of the stomach contents with a particular meal eaten at an identifiable time. An area of considerable controversy, however, is autopsy estimation of the time interval between the eating of the last meal and death. The accuracy of estimates of this nature are dependent upon the reliability of data on gastric emptying. In his memoirs Sir Sidney Smith (1959) describes a remarkable case (the Hopetown Quarry Murder) of two boys, one aged four years and the other nearly seven, who were drowned in a water-filled quarry. The crime was committed by their father, Patrick Higgins, in November 1911. It was not until June 1913 that the bodies were recovered and by that time both bodies had been almost wholly transformed into adipocere. The internal organs were well preserved and Sir Sidney Smith described the stomachs as follows:
23 citations
TL;DR: It is suggested that death can occur from uncomplicated alcohol poisoning where there is a post-mortem blood alcohol level above 250 milligrams per 100 millilitres, but that where there are asphyxial complications then these may lead to death with blood alcohol levels below that figure at autopsy.
Abstract: A retrospective survey was carried out of all cases where death had resulted from the complications of excessive alcohol consumption in order to determine what constituted a lethal level of alcohol intake. The cases fell into two groups, one where there was an element of asphyxia which had complicated the effects of alcohol and led to death and those where death was entirely due to uncomplicated alcohol poisoning. It is suggested that death can occur from uncomplicated alcohol poisoning where there is a post-mortem blood alcohol level above 250 milligrams per 100 millilitres, but that where there are asphyxial complications then these may lead to death with blood alcohol levels below that figure at autopsy
22 citations
TL;DR: This paper presents, in part, some results emerging from the study of the causes of the rising incidence of suicides in the city of Adelaide in 1982-83.
Abstract: INTRODUCTION Leaping from high places is one of the least common methods of suicide in Australia, accounting for less than 5 per cent oL111 suicides over the years 1961-81 (Australian Bureau of Statistics). A marked increase in this form of suicide in the city of Adelaide in 1982-83, and the high proportion of cases involving multistorey car parks, became a matter of public concern. The City Council, who owned the two principal car parks involved, came under increasing media criticism and initiated a study of the causes of the rising incidence of these suicides. This paper presents, in part, some results emerging from the study.
16 citations
TL;DR: The situation is reviewed and the conclusion is drawn that complaints are often justified on the basis of organic pathology, and that an unduly dismissive attitude is probably adopted towards the psychiatric sequelae of head injury.
Abstract: Numerous complaints of a characteristic type often follow head injury, and plaintiffs have to convince the court that these complaints represent a genuine disability, and do not emanate from expect...
TL;DR: Analysis of the errors between the actual post-mortem period and the calculated time since death indicate that accuracy depends on the shape of the cooling curve.
Abstract: Derivations of an equation for determining time since death are shown based on Brown and Marshall's (1974) double exponential cooling curve of the human corpse. Five cases of known time of death are then compared with the estimated time of death incorporating the technique described in this paper. Analysis of the errors between the actual post-mortem period and the calculated time since death indicate that accuracy depends on the shape of the cooling curve.
TL;DR: Nearly 50 per cent of referrals for admission to one medium secure unit were refused a bed, in line with rates elsewhere in the country, so factors potentially relevant to admission decisions were examined.
Abstract: Nearly 50 per cent of referrals for admission to one medium secure unit were refused a bed. This is probably in line with rates elsewhere in the country, so factors potentially relevant to admission decisions were examined. Violent behaviour was the most powerful patient variable in determining admission. A minority of patients were rejected as clinically unsuitable. Lack of resources was the most likely precipitant of rejection. Unavailability of beds or staff also created long delays in admission.
TL;DR: Five sudden deaths resulting from the deliberate inhalation for euphoric effect of the contents of BCF-type fire extinguishers are reported.
Abstract: Solvent abuse or glue-sniffing has become an increasing problem in the young and a wide variety of substances have been involved. Bromochlorodifluoromethane (BCF) is a vapourizing liquid fire-extin...
TL;DR: A study of the case notes of 101 patients at Broadmoor Hospital yielded 89 with a past history of psychosis, of whom 14 had suffered delusions of poisoning, in all but one the symptom seemed an important antecedent factor to serious violence, the imagined poisoner almost always being one of the victims.
Abstract: A study of the case notes of 101 patients at Broadmoor Hospital yielded 89 with a past history of psychosis, of whom 14 had suffered delusions of poisoning. In all but one the symptom seemed an important antecedent factor to serious violence, the imagined poisoner almost always being one of the victims. The possible aetiology and the predictive importance of the symptom are discussed.
TL;DR: A case of infantile xanthomatous cardiomyopathy, presenting as a cot death, is described and the aetiology of the lesion discussed.
Abstract: A case of infantile xanthomatous cardiomyopathy, presenting as a cot death, is described. The literature is reviewed and the aetiology of the lesion discussed.
TL;DR: The majority of the normal accused were young, between 15–24 years, compared with most of the abnormal accused who were between 25–34 years, and alcohol intoxication was noted in 24 per cent of cases and EEG abnormality in one case.
Abstract: In this study of homicide in Singapore, case records were examined of 75 accused (72 men and 3 women), 8 (10.6 per cent) of whom showed evidence of mental abnormality. The majority of the normal accused were young, between 15–24 years, compared with most of the abnormal accused who were between 25–34 years. Alcohol intoxication was noted in 24 per cent of cases and EEG abnormality in one case. The most popular weapon used was a sharp instrument and there was only one death from gunshot wounds. Most of the victims of the normal accused were strangers (78 per cent) but 6 out of the 10 victims of the abnormal accused were relatives, friends or neighbours.
TL;DR: The extent of the contribution of drivers impaired by drugs and drug-alcohol interaction to traffic accidents has not yet been defined and will not be defined until all countries enact effective legislation to enable such drivers to be identified.
Abstract: The effect of any one psychoactive drug on an individual is a function of its interaction with that individual; for this reason, the effect upon one person may not be the same as on another person. When two or more drugs are given at the same time, their effect may be one of antagonism, synergism or potentiation. The effects of a psychotropic drug (ataxia, incoordination, altered level of consciousness or awareness, disturbances of vision and increased reaction time) must surely impair the skills required for safe driving. Many prescribed drugs acting principally on the central nervous system are capable of impairing driving performance: analgesics, anti-depressants, anti-convulsants, sedatives, hypnotics, narcotics and tranquillizers. Other prescribed drugs: anti-histamines, hypotensive agents, hypoglycaemic substances may produce undesirable side effects which impair driving performance. In Queensland if breath analysis indicated a BAC too low to account for a driver's behaviour, a doctor is called to examine the driver, and samples of blood and urine are forwarded to a central laboratory. If the blood concentration of a drug equals or exceeds the accepted therapeutic level of the particular substance, the driver is considered to be "under the influence" of the drug. The most dangerous period is during the initial stage of taking a prescribed drug. Psychotropic drugs taken in prescribed dosage may initially produce drowsiness, ataxia, impaired judgement and increased reaction time. After a period of time, tolerance to the drug develops, with marked reduction in unwanted side effects. The most common drugs include morphine, pethidine, methadone, methaqualone, benzodiazepines, and barbiturates. The common purpose for such abuse is to get "high" -a stage of unreality characterized by euphoria and/or hallucinations, either visual or auditory or both. Intoxication by any of these drugs produces severe impairment of driving skills. An exaggerated pharmacological effect commonly occurs when alcohol is taken at the same time as another psychoactive drug. Benzodiazepines are the prescribed drug most commonly involved in instances of driving impairment, both alone and in combination with alcohol. Some drugs commonly associated with impaired driving performance are: mandrax, methadone and diazepam. The extent of the contribution of drivers impaired by drugs and drug-alcohol interaction to traffic accidents has not yet been defined. It will not be defined until all countries enact effective legislation to enable such drivers to be identified. The use of alcohol and psychotropic drugs in Australia has been increasing steadily over the past few years, and continues to increase. It is impossible to obtain accurate figures on the consumption of psychotropic drugs in Australia. (Shortened Author Abstract/TRRL)
TL;DR: This paper was submitted in May 1985 and drafts circulated and subsequent events and legislation focused on football matches has incorporated some of the suggestions contained herein.
Abstract: Football hooliganism and a spate of riots in Brixton, Toxteth, Moss Side, Southall, Wandsworth and very recently Handsworth and the unrest on union picket lines has reawakened interest in crowd beh...
TL;DR: This paper concerns such a phenomenon occurring in a child with a history of hypothermia found to have discarded their clothes just before becoming unconscious.
Abstract: The phenomenon of people removing their clothes whilst suffering from the effects of extreme cold is well recognized, but the references have been almost anecdotal (Gee, 1974).Victims of hypothermia have been found to have discarded their clothes just before becoming unconscious (Gormsen, 1972; Wedin et al., 1979).In all the cases described in the literature, the victims have always been adults. This paper concerns such a phenomenon occurring in a child.
TL;DR: There has been relatively little study of the 'psychology of the crowd'-this is surprising because crowd behaviour in one form or another appears to have been a significant feature of most historical periods in the UK, both in sporting and non-sporting contexts.
Abstract: INTRODUCTION There has been relatively little study of the 'psychology of the crowd'-this is surprising because crowd behaviour in one form or another appears to have been a significant feature of most historical periods in the UK, both in sporting and non-sporting contexts. The recorded activities of the Luddites and the Chartists in the 19th century, for example, make recent events in Brixton and Toxteth, as well as those in the Nottinghamshire coal fields, appear to be minor skirmishes. In the sporting arena, the early days of football, prior to the introduction of referees and other governing bodies, were characterized by games between whole villages lasting up to two or three days in length. Such games were frequently the occasion for mass violence, so much so that the game was officially banned as being 'unseemly' by the Synod of Exeter in 1287, and later by Edward III in 1349 (cf. Taylor, 1971). On the other hand, it is perhaps not so surprising that psychology as a discipline has paid little attention to crowd behaviour, for two reasons. First, in their attempt to attain status as truly scientific researchers,. psychologists have generally relied on laboratory-based studies using rigorous control techniques. Most phenomena occurring in the real world can, it has been argued, be effectively isolated under such conditions to enable causal relations to be determined. While this approach is adequate for many areas of interest to psychologists, it is clearly not appropriate for the study of crowd
TL;DR: Conduction system studies do not seem to increase the accuracy of routine autopsy diagnosis in deaths due to coronary artery disease, however, its study in unexpected sudden death in the young should be made compulsory and the difficulties in performing choline esterase tests on conduction systems highlighted.
Abstract: The histopathology of the cardiac conduction system was studied in 75 coroners' autopsies. Existing methods have been simplified and are described in detail. A minimum of three ***5 u sections need to be cut from each vena cavo atrial strip and each atrio ventricular block, for a successful result. Reasons for failure, difficulties in interpretation, and age-related changes in histopathological features are discussed. Fatty infilteration commences at 33 years old and fibrosis at 43 years old. Conduction system studies do not seem to increase the accuracy of routine autopsy diagnosis in deaths due to coronary artery disease. However, its study in unexpected sudden death in the young should be made compulsory. The difficulties in performing choline esterase tests on conduction systems are also highlighted.
TL;DR: An analysis of the presence of alcohol amongst 406 cases of violent accident or suicide (excluding road traffic accidents and drug overdoses) showed a basic association between alcohol and accident as opposed to suicide.
Abstract: An analysis of the presence of alcohol amongst 406 cases of violent accident or suicide (excluding road traffic accidents and drug overdoses) showed a basic association between alcohol and accident...
TL;DR: The case files of the Office of the Medical Examiner, Metro Dade County (Miami, Florida, USA), were studied over a three-year period, 1981–83 and cases in which an elderly person died as a direct or indirect result of a fall were examined.
Abstract: The case files of the Office of the Medical Examiner, Metro Dade County (Miami, Florida, USA), were studied over a three-year period, 1981–83. Those cases in which an elderly person died as a direct or indirect result of a fall were examined and analyzed as to age, race, sex, ultimate cause of death, location of trauma, scene circumstances, whether the patient was hospitalized and duration of any hospitalization. A total of 159 cases were so examined.
TL;DR: A brief survey of the anaesthetic problems encountered in patients acutely intoxicated by ethyl alcohol is proposed, based upon a case report, and a practical approach is proposed for the anaesthesia management of such patients.
Abstract: This article, based upon a case report, proposes a brief survey of the anaesthetic problems encountered in patients acutely intoxicated by ethyl alcohol. During the entire period of an eventual surgical involvement, prolonged intensive care is necessary to prevent complications as the Mendelson's syndrome, respiratory depression and delirium tremens. A practical approach is proposed for the anaesthetic management of such patients.
TL;DR: There has been a substantial increase in litigation for failure of sterilization operations and it is suggested that female sterilization should be renamed tubal occlusion.
Abstract: There has been a substantial increase in litigation for failure of sterilization operations. Recent court cases indicate that doctors must inform their patients about the risk of failure of such op...
TL;DR: What would be helpful to parents, doctors and judges alike in deciding the gravity of birth impairment and ultimately whether to maintain life or allow it to abate with dignity and mercy would be criteria which would attempt to structure pragmatic medical standards for decision-making.
Abstract: Whenever a genetically defective infant is born, a triptych of interests is challenged directly. For such a case not only tests the extent of the natural rights of the parents in making decisions regarding the infant's capacity for qualitative life, but the personal needs or the welfare of the child itself and the nature of the responsibilities of the State in ensuring the welfare of its citizens regardless of age or infirmity. Aggressive posturing by the United States government, through a complex regulatory scheme designed to assure protection of handicapped newborns, has in fact wreaked havoc on the whole decision-making process and assaulted the integrity and privacy of the family decisional unit. While lacking a similar governmental regulatory process of protection in England, the judiciary, nevertheless, has given a strong indication that circumstances may merit respect of parental decisions which preclude aggressive efforts being undertaken to maintain life for such infants. What would be helpful t...
TL;DR: A case of infantile xanthomatous cardiomyopathy, presenting as a cot death, is described and the aetiology of the lesion discussed.
Abstract: A case of infantile xanthomatous cardiomyopathy, presenting as a cot death, is described. The literature is reviewed and the aetiology of the lesion discussed. INTRODUCTION Cot death is a very emotive subject. In Ayrshire (population 450,000 approximately) between four and 22 cases occur per annum. A very small proportion of these are 'explained', e.g, acute epiglottitis, meningococcal septicaemia, haemophilus pneumonia, coxsackie myocarditis and congenital heart lesions. Failure to establish a cause of death is essential to the diagnosis of Sudden Infant Death Syndrome (SIOS). The case described in this paper was considered on gross examination to be SIDS but histological examination 'explained' the death. CASE REPORT A female infant, aged 14 months, the youngest of a family of four, was found dead in her cot at 8 a.m. by her mother. On the previous day the child had been rather listless and chesty and had refused solid food at lunch-time and at evening meal. She was given a 7 oz. milk feed and put to bed. The parents retired to bed at 11.40 p.m. and finding the child awake and lively the mother gave her another 3 oz. milk feed and again put her to bed, where she was seen to fall asleep. This baby was born at full-term by spontaneous vertex delivery. One week after birth the infant was admitted to the local childrens hospital because of a 'convulsion', thought to have been caused by slow healing and resultant infection of the umbilical cord. She had recurrent respiratory problems from birth until aged 3 months, when she was again admitted to the children's hospital with a chest infection. Thereafter the baby appeared to thrive, was lively and had a good appetite, although was said to be delicate in build and stature. The police and a police surgeon investigated the death and found no evidence of injury on the child. The bedroom was untidy and poorly decorated but was warm, being heated by an electric convector heater. An autopsy examination was carried out at the request of the Procurator Fiscal. The body was that of a well-nourished female infant.